Cardiac Patients Research Articles

The early decline in platelet count is associated with increased adverse outcomes in non heparin-induced thrombocytopenia pediatric patients undergoing VA-ECMO.

The impact of non heparin-induced thrombocytopenia on the clinical outcomes for pediatric cardiac surgery patients who required veno-arterial extracorporeal membrane support (VA-ECMO) for failure to wean from cardiopulmonary bypass (CPB) is uncertain. This study aimed to investigate the relationship between thrombocytopenia and prognosis in these patients. This retrospective study enrolled 96 pediatric patients (age < 18) who received VA-ECMO directly transitioned from CPB at Fuwai Hospital from January 2010 to June 2020. The association between relative decrease in platelet count (△PLT) post-ECMO 24h and clinical outcomes was explored. There were significant differences in Post-ECMO 24h platelet counts, platelet count nadir, and duration of platelet decline between the survivors and non-survivors in CPB-ECMO groups. A positive correlation was found between △PLT post-ECMO 24h and plasma-free hemoglobin (pFHb) (p = .014, r = 0.305), peak serum creatinine (p = .016, r = 0.299), peak AST (p = .014, r = 0.302), duration of platelet transfusion (p = .032, r = 0.270),The △PLT post-ECMO 24h had predictive value on in-hospital mortality [(p < .001, AUROC = 0.781 (95% CI: 0.670-0.892)], massive bleeding (p = .001, AUROC 95% CI: 0.627-0.870), hemolysis (p = .046, AUROC 95% CI: 0.510-0.780), and nosocomial infection (p = .020, AUROC 95% CI: 0.536-0.801). Multivariate logistic regression showed that △PLT post-ECMO 24h was associated with in-hospital mortality and hemolysis. The relative early decrease in platelet count 24h following transition to ECMO is associated with increased patient mortality, and is positively associated with adverse outcomes in pediatric cardiac surgery patients transferred from CPB to ECMO. Moreover, this decline rate can predict in-hospital survival, major bleeding, hemolysis, and hospital-acquired infections.

Differences in 6-Minute Walk Distance Across Heart Disease Recurrence Risk Levels in Cardiac Rehab Patients

Background/Objectives: Cardiac rehabilitation (CR) programs are multi-component interventions comprising structured strength and cardiovascular exercise training, psychological support, education, and therapies to promote positive lifestyle changes. This study aimed to determine if there are differences in the 6-minute walk distance (6MWD) across risk groups for recurrent heart disease. Methods: This retrospective cohort study used existing data collected from electronic medical records. The 6-minute walk distance was measured at baseline (pre-6MWD) and upon the completion of the CR program (post-6MWD). Short-term cardiac event recurrence risk was determined using a two-year recurrent coronary heart disease (2yRCHD) risk percentage, calculated according to the Framingham 2yRCHD calculator. Risk was then stratified into (1) low, (2) moderate, and (3) high-risk groups. Demographic variables (e.g., age, sex, racial/ethnic group) and clinical variables (e.g., BMI, lipid panels, fasting glucose levels, comorbidities) were collected to describe the study participants and identify potential confounders. An ANOVA and ANCOVA were performed to examine the differences in 6MWD across the 2yRCHD risk groups. Results: A total of 394 CR participants’ data were included in this analysis. Ninety-nine percent of the female participants were classified as low risk for recurrent heart disease, resulting in an extremely small sample size in the moderate-risk (n = 1) and no representation (n = 0) in the high-risk group. This lack of representation made it impossible to conduct comparative analyses across all the participants or to analyze female participants separately by risk category. Consequently, only male participant data were included in the final analysis. The study showed that pre- and post-6MWD measurements were significantly different across the three 2yRCHD risk groups (p = 0.006 for pre-6MWD; p = 0.002 for post-6MWD). The ANCOVA indicated that these differences were independent of the selected covariates. Post hoc analyses revealed significant differences in 6MWDs between the low- and high-risk groups and between the moderate- and high-risk groups, but not between the low- and moderate-risk groups, for both pre- and post-6MWD measurements. Compared to the CR participants in the high-risk group, those in the low- and moderate-risk groups achieved significantly longer distances in the 6-minute walk tests. Conclusions: The observed differences in the 6MWD across short-term cardiac recurrence risk levels suggest its potential as a simple, accessible tool for assessing cardiac recurrence risk levels in community settings. Further research is needed to generalize these findings to more diverse populations and to support aging in place for older adults living with heart disease.

Anticoagulation with warfarin for paediatric cardiac indications: a retrospective study.

Warfarin is used as anticoagulation for children for a wide range of cardiac indications but carries the disadvantage of requiring international normalised ratio monitoring and dose adjustment. Management of warfarin therapy is challenging due to its narrow therapeutic window and is further complicated in children by dietary changes, frequent illnesses, and developing systems of metabolism and haemostasis.A retrospective review was performed of patients' medical records to assess the indication for warfarin use, percentage of international normalised ratio values in target range (%ITR), and frequency of phlebotomy.Twenty-six patients were identified. The most common indication for warfarin use was in patients post-total cavo-pulmonary connection (n = 19, 73%). We demonstrated a variability in duration of warfarin therapy following total cavo-pulmonary connection (median of 11.1 months). Nineteen (73%) patients had used the CoaguChek machine for home measurement of international normalised ratio. The median frequency of phlebotomy for all indications was once every 10 days, and the median %ITR was 55.4 % (29.7-86.4%). Of note, the percentage under target range in the patients with mechanical mitral (n = 2) and aortic valves (n = 1) was found to be 23% and 33%, respectively.These data demonstrate a high frequency of international normalised ratio values outside of the target range as seen in previous studies of warfarin in children. This necessitates frequent phlebotomy and dose changes, which can have a significant effect on the quality of life of these patients and their families highlighting the need to focus on quality improvement in the area of anticoagulation in paediatric cardiac patients.

National outcomes for dementia patients undergoing cardiac surgery in a pre-structural era.

With an aging population and higher prevalence of dementia, there is a paucity of data regarding dementia patients undergoing cardiovascular surgery. We examined the nationwide trends and outcomes of cardiovascular surgery patients with dementia to determine its effect on morbidity, mortality, and discharge disposition. From 2002 to 2014, 11,414 (0.27%) of the 4,201,697 cardiac surgery patients from the Nationwide Inpatient Sample had a preoperative diagnosis of dementia. Propensity-score matching was used to balance dementia and non-dementia groups. Primary outcomes included postoperative morbidity, mortality, and discharge to skilled nursing facility (SNF). Dementia patients were more often male (67%) and 65-84 years old (84%). Postoperative mortality among patients with dementia was lower compared to patients without dementia (3.4% vs. 4.6%, p < 0.05). In dementia patients, there were more complications (65% vs. 60%, p < 0.01), more blood transfusions [OR 1.3, 95%CI (1.1, 1.5), p < 0.01] and delirium [OR 3.6, 95%CI (2.9, 4.5), p < 0.0001). Dementia patients (n = 5,623, 49.8%) were twice as likely to be discharged to SNF [OR 2.1, 95%CI (1.9, 2.4), p < 0.0001]. Dementia patients discharged to SNF more often had delirium (18.2% vs. 12%, p < 0.01), renal complications (17% vs. 8%, p < 0.01), and prolonged mechanical ventilation (15% vs. 8%, p < 0.01). Despite an aging population with increasing prevalence of dementia, patients with dementia can undergo cardiovascular surgery with a lower in-hospital mortality and similar hospitalization costs compared to their non-dementia counterparts. Dementia patients are more likely to experience complications and require discharge to skilled nursing facility. Careful patient selection and targeted physical therapy may help mitigate some dementia associated complications.

Outcomes Associated with Novel Oral Anticoagulants and Warfarin in Patients with Cardiac Thrombus Following STEMI.

The treatment of cardiac thrombus after ST-segment elevation myocardial infarction (STEMI) is anticoagulation. There is conflicting data on effectiveness and safety of novel oral anticoagulants (NOACs) vs. warfarin. Using the national Medicare data, we identified patients with an admission diagnosis of STEMI and cardiac thrombus within six months after STEMI. Patients were divided into two groups based on initial type of anticoagulation medication (NOACs vs. warfarin). The two main outcomes were ischemic stroke/transient ischemic attack (TIA) and bleeding. Follow-up was performed through the end of 2023. Kaplan-Meier (KM) Curves and Cox proportional hazard models were utilized. Of 881 patients prescribed anticoagulation after STEMI with subsequent cardiac thrombus, 496 patients were prescribed NOACs (56.3%) and 385 patients (43.7%) warfarin. For ischemic stroke, the median follow-up time was 177 days (95% CI: 148-193) for warfarin and 266 days (95% CI: 204-326) for NOACs. There was significantly lower risk of ischemic stroke or TIA in cardiac thrombus patients treated with NOACs compared to warfarin [HR 0.73 (0.57-0.93)]. For bleeding, the median follow-up time was 192 days (95% CI: 175-232) for warfarin and 277 days (95% CI: 212-332) for NOACs. There was also a lower risk of bleeding in patients treated with NOACs compared to warfarin [HR 0.78 (CI 0.66-0.92)]. In conclusion, STEMI patients with cardiac thrombus had lower risk of ischemic stroke and bleeding when treated with NOACs compared to warfarin. Prospective randomized studies are needed to confirm these findings and further examine the comparative effectiveness of different anticoagulant strategies.

Abstract Su1202: The utility of post cardiac arrest temperature control protocol according to the severity of hypoxic encephalopathy based on amplitude-integrated electroencephalography findings

Introduction: The TTM2 trial showed that active fever prevention below 37.5°C and hypothermia at 33°C had similar outcomes in out-of-hospital post cardiac arrest patients. However, the patients in the trial had mild hypoxic encephalopathy, and the effects of hypothermia may vary with its severity. We previously reported that amplitude-integrated electroencephalography (aEEG) findings after the return of spontaneous circulation can be used to categorize the severity of hypoxic encephalopathy (Crit Care. 2018;22:226). In September 2022, we adopted a new temperature control protocol wherein the target temperature was set based on aEEG findings. This study examined changes in outcomes before and after implementing this new protocol. Methods: We assessed out-of-hospital cardiac arrest patients who received post cardiac arrest care in our emergency intensive care unit between March 2021 and February 2024. We divided the patients into two groups: before (B) and after (A) the introduction of the new protocol. We classified the patients into categories 1 (C1) to 4 (C4) based on the severity of hypoxic encephalopathy (Figure 1). All patients in group B were treated with hypothermia at 34°C. In group A, patients in C1 were treated with active fever prevention, and those in C2–C4 received hypothermia at 34°C (Figure 2). Primary outcome was favorable neurological outcomes (cerebral performance categories of 1 or 2) at hospital discharge. Secondary outcome was the duration of mechanical ventilation. Results: A total of 160 patients were included. The median age was 62 years and 105 (66%) patients had cardiac etiology. Fifty-five (34%) patients underwent extracorporeal cardiopulmonary resuscitation. The median cardiac arrest time was 29 min. Groups B and A comprised 57 and 103 patients, respectively. C1 category comprised 20 and 28 patients in groups B and A, respectively. The rate of favorable neurological outcomes was 35% in both B and A groups (p=1.00). Regarding C1 patients, the rates were 90% and 86% in B and A groups (p=1.00). Median duration of mechanical ventilation was 5 and 3 days in group B and A, respectively (p=0.11). Conclusion: Neurological outcomes before and after introducing the new protocol were similar. Management of patients with mild hypoxic encephalopathy can be simplified with active fever prevention. A temperature control protocol based on the severity of hypoxic encephalopathy using aEEG findings is feasible for emergency physicians.

Abstract 4136509: Children in Foster Care with Heart Disease Have Greater Resource Utilization and Mortality

Background: While children and youth in foster care (CYFC) have greater healthcare needs generally, data are lacking in heart disease. We characterize CYFC with heart disease, assess the impacts of being in foster care on outcomes, and examine validity of ICD-10 code Z62.21 for identification of CYFC in administrative data. Methods: In this single-center, retrospective cohort study of all cardiac surgical patients (&lt;18yo) admitted 2017-2022, CYFC were identified using institutional Electronic Medical Records via natural language processing or ICD codes, with confirmation by chart review. Demographics, medical characteristics and outcomes of CYFC were compared to children not in foster care. Generalized linear models assessed associations with primary outcomes of mortality at current follow-up (logit link) and total hospital days (log link), controlling for clinical factors and length of follow-up. We separately added Child Opportunity Index (COI) and payer to models. This cohort was then studied in the administrative pediatric health information system (PHIS) dataset to calculate ICD code sensitivity and specificity. Results: Of 4,431 cardiac surgical patients, 67 (1.5%) were in foster care. CYFC did not have significantly higher mortality (9% vs 5.8%), 30-day readmission or cardiac reoperation, number of complex chronic conditions (CCC), RACHS-2, or distance from center compared to non-CYFC. CYFC had lower COI (median 61 vs 72, p=0.016) and more Medicaid coverage (87% vs 40%, p&lt;0.001). Length of stay after index surgery was similar; however, cumulative hospital days during the study were significantly higher for CYFC (median 22 [IQR 10,45] vs 12 [6,27], p&lt;0.001). Adjusting for RACHS-2, CCC, age, readmission, reoperation, and follow-up duration, CYFC had higher odds of mortality (2.7 [95%CI 1.0,6.9] p=0.046) and more total hospital days (p=0.008). With COI or payer in the model, CYFC was not associated with mortality but remained an independent risk factor for more total hospital days. Only 16/67 (23.9%) of CYFC were coded with the Z62.21 in PHIS, yielding sensitivity of 21.9% (95%CI 13.1,33.1), and specificity of 100% (99.9,100). Conclusion: CYFC with heart disease have a relative social disadvantage, greater hospital resource utilization, and long-term mortality despite similar illness severity. Improved capture of foster care status in administrative data is needed to guide future studies and reduce health disparities for the vulnerable population of CYFC.

Abstract Su907: Post-Cardiac Arrest Potassium Abnormalities Associated With Unfavorable Functional Outcome

Background: Abnormal potassium levels are common findings in the intensive care unit (ICU) population. We aimed to determine the incidence of dyskalemias at ICU admission and their association with functional outcome in comatose patients resuscitated from cardiac arrest. Hypothesis: We hypothesized that both hypokalemia and hyperkalemia are associated with unfavorable functional outcome. Methods: Pooled data from four randomized clinical trials in comatose post-cardiac arrest patients admitted to ICU after return of spontaneous circulation (ROSC). Reference potassium levels were defined as between 3 and 4.9 mmol/L, as proposed in the Simplified Acute Physiology Score II. Favorable functional outcome was defined as a Cerebral Performance Category of 1 or 2 at 180 days. Results: We included 1133 patients (557 from HYPERION, 346 from TTH48, 120 from COMACARE and 110 from Xe-HYPOTHECA) with a median age of 64 (IQR: 55-72) years and a predominance of males (72%). Overall, 421 (36%) patients had favorable functional outcome. On admission, 221 (19.5%) patients experienced hyperkalemia and 35 (3.1%) patients experienced hypokalemia. More patients in the normokalemia group (364/877, 41.5%) had a favorable functional outcome, as compared to the hypokalemia (11/35, 31.4%) and hyperkalemia (41/221, 18.6%) groups p&lt;0.001). In a mixed-effects logistic regression model including initial rhythm, delay from collapse to ROSC, bystander cardiopulmonary resuscitation, lactate, and urea and with normokalemia as reference group, hyperkalemia was associated with higher odds for unfavorable functional outcome (OR 1.85, 95% CI 1.10-3.12, p=0.02) whereas hypokalemia was not (OR 1.36 95% CI 0.51-3.60, p=0.53). Conclusions: One fifth of unconscious cardiac arrest patients experienced dyskalemia on ICU admission. Hyperkalemia was associated with unfavorable functional outcome at 180 days compared to normokalemia, whereas hypokalemia was not an independent predictor of outcome.

Abstract 4137441: Online Cognitive Behavioral Therapy Targeting Psychological Distress Following Open Heart Surgery: An Uncontrolled Pilot Study

Background: Cardiac surgery is a significant procedure that reduces mortality and alleviates symptom burden in individuals with cardiovascular diseases. However, many patients develop depression and cardiac-related anxiety postoperatively, which negatively affects long-term prognosis and rehabilitation. There is a clinical need to develop scalable psychological treatments to mitigate these negative health effects. Objective: To investigate the feasibility and potential efficacy of a brief internet-delivered cognitive behavioral therapy (internet-CBT) intervention to reduce psychological distress in patients following cardiac surgery. Methods: The pilot study included 32 cardiac surgery patients (i.e., CABG, heart valve repair/replacement, aortic repair, or combined CABG and valve repair/replacement) with endorsed postoperative psychological distress and/or interference with daily life who underwent surgery from eight weeks to nine months prior to enrollment. Exclusion criteria included prior cardiac surgery with a ventricular assist device or heart transplant and severe medical or psychiatric illness. The internet-CBT targeted cardiac anxiety and depressive inactivity, lasted for five weeks, and was guided by clinical psychologists via text-based interactive online treatment modules. It included interoceptive exposure, in-vivo exposure, and behavioral activation. Self-assessments were completed at pre-treatment, post-treatment, and at 6-month follow-up. Results: Preliminary analyses post-treatment showed substantial pre-post improvements across multiple domains. Notable findings included significant reductions in depressive symptoms (Cohen’s d = 0.70; p = 0.04), cardiac anxiety (Cohen’s d = 1.53; p &lt; 0.001), and perceived severity of post-operative symptoms (Cohen’s d = 1.06; p = 0.006). Participants demonstrated high adherence to the treatment, with the large majority of participants completing all five treatment modules (83.3%). Satisfaction with the treatment was also high (25.5 points out of 32), as measured by the Client Satisfaction Questionnaire, and no adverse events were reported. Conclusion: This novel internet-CBT intervention post-cardiac surgery appears to be feasible, acceptable, and clinically promising in reducing postoperative psychological distress. It could be used as a viable adjunct treatment to enhance recovery post-cardiac surgery. These preliminary findings warrant further testing in a randomized controlled trial.

Abstract Su205: Using Emergency Medical Services Monitors for Cardiac Arrest Patients in the Emergency Department is Associated with Faster Initial Rhythm Analysis and Defibrillation

Introduction: The 2020 American Heart Association guidelines for Cardiopulmonary Resuscitation (CPR) emphasizes the importance of high-quality CPR and early defibrillation in improving cardiac arrest (CA) survival. Using our emergency department (ED) CA video review registry, we can capture metrics to reliably assess the effectiveness of different approaches to CA management. Goals/Hypothesis: We propose that emergency medical services (EMS) pads and defibrillators should be used to initially analyze cardiac rhythm in the ED. We hypothesize that this “EMS Equipment” approach is associated with shorter time to first ED rhythm detection and defibrillation, higher chest compression fraction (CCF), and improved return of spontaneous circulation (ROSC) rates. Methods: This is a single center, retrospective cohort study using our CA video review registry between 10/03/2018 – 2/20/2024. Atraumatic, out-of-hospital CA patients ≥18 years were included while patients arriving to the ED with ROSC were excluded. The “EMS Equipment” group utilized EMS pads and defibrillators while the “ED Equipment” group utilized ED pads and defibrillators for the first ED rhythm analysis. Wilcoxon rank sum tests were used to assess differences in time to first rhythm check and first defibrillation among the two groups. Chi-square tests were used to assess whether the proportions of patients achieving above median CCF, ROSC, survival to admission and discharge in the two groups were different. Results: A total of 247 patients were included in the analysis with 69 patients in the EMS Equipment group (27.9%) and 178 patients in the ED Equipment group (72.1%). The EMS Equipment group had a shorter median time to first ED rhythm detection (96 vs. 255 seconds, p &lt;0.00001). Among the 63 patients defibrillated in the ED, the EMS Equipment group had a shorter median time to first ED defibrillation (103 vs. 413 seconds, p = 0.0024). There was no significant difference in CCF, ROSC rates, survival to admission or discharge. ROSC was achieved in 36% of cases. Conclusion: In conclusion, initial rhythm analysis with EMS pads and defibrillators was associated with shorter time to initial ED rhythm detection and defibrillation, but not improved CCF, ROSC rates, and survival. Larger studies are needed to verify these exploratory results in more diverse settings.

Abstract Su507: Occurrence of Fibrillation in Out-of-hospital Cardiac Arrest Patients Presenting in a Non-shockable Rhythm when Treated with an Automated External Defibrillator

Background: Most out-of-hospital cardiac arrest (OHCA) patients who are initially treated with an automated external defibrillator (AED) and present in a non-shockable rhythm never receive a shock. This analysis reports on patients who presented in a non-shockable rhythm when the AED was initially applied and later transitioned into a shockable rhythm. Methods: Data from a convenience group of OHCA patients treated with a Philips HeartStart Home, Onsite or FRx AED were included. The AEDs were the first defibrillator on scene either in home, in public access or by a BLS team. Application of any medication during AED use was unlikely. Each patient’s heart rhythms were reviewed by an expert. All patients whose initial rhythm was non-shockable but later received at least one shock were identified and the rhythms were analyzed. Results: Out of 876 patients, 322 (36.8%) received at least one shock, of which five patients (1.6%) presented in a non-shockable rhythm and were later shocked. Three patients presented in an organized rhythm. The first patient degraded into Torsade de Pointe as shown in Figure 1; the post-shock rhythm was organized. The second patient received no CPR and A-V pacing was observed in the ECG recording. The pacing stopped when the rhythm transitioned into VF and restarted post shock. The third patient transitioned into VF during chest compressions and the post-shock rhythm was asystole. The remaining two patients presented in asystole and the rhythm evolved to fine VF after receiving chest compressions. After defibrillation, their rhythms returned to asystole. Conclusions: For OHCA patients treated with an AED, presenting in a non-shockable rhythm and later transitioning into a shockable rhythm is rare but possible. Lay-responder CPR may play a role in rhythm evolvement. The impact of rhythm changes on survivability of these patients is unknown.

Abstract 4137543: Prevalence, Genetic Correlates and Prognostic Significance of an Apical Pseudo-Infarct Late Gadolinium Enhancement Pattern in LMNA -Mediated Cardiac Laminopathy

Background: Disease-causative variants in LMNA -encoded lamin A/C cause a genetic cardiomyopathy characterized by atrioventricular (AV) block, atrial fibrillation (AF) and ventricular arrhythmias (VA). Whether domain/variant-specific late gadolinium enhancement (LGE) patterns exist and carry prognostic significance is unclear. Objective: To determine if specific LGE patterns correlate with LMNA variant type/missense variant localization and clinical outcomes in a large cohort of cardiac laminopathy patients. Methods: Retrospectively, 621 genotype-positive arrhythmogenic/dilated cardiomyopathy patients were analyzed to identify those with a disease-causative variant in LMNA -encoded lamin A/C. After exclusion of patients without cardiac magnetic resonance data, pertinent demographic/clinical data was extracted from the electronic medical record. LGE distribution (subepicardial, midmyocardial, subendocardial, transmural) and location (septal, free wall, apical) patterns were analyzed by variant type (missense vs truncating) and missense variant localization (central rod domain vs tail domain) and correlated with advanced heart failure (AHF), MVA, AV block, AF and thromboembolic (TE) events. Results: 70 out of 116 (60%) LMNA variant-positive (mean age 39±12, 43% male and 94% Caucasian) were included. Missense variants localizing to the C-terminal tail region showed a higher prevalence of transmural and apical LGE (Table). Amongst the 5 (7%) patients with this distinct apical pseudo-infarct LGE pattern, p.Arg471His-LMNA was identified in all cases. Among the 48/70 (69%) of patients with clinically manifest disease, p.Arg471His-LMNA-positive patients (n=6) were noted to have an increased prevalence of TE events [3 (50%) vs 5 (12%), 0=0.050] despite a reduced prevalence of AF [2 (33%) vs 32 (76%), p= 0.031]. No difference in AHF or MVA were observed, but AV block was less prevalent [1 (20%) vs 29 (74%), p= 0.029]. Conclusion: p.Arg471His-LMNA causes a distinct apical pseudo-infarct LGE pattern associated with an increased risk of TE events and a decreased prevalence of AV block and AF. Future studies are needed to better refine the role of domain/variant-specific risk-stratification/anticoagulation in cardiac laminopathy.

Abstract 4138620: Assessment of the Accuracy of the Perioperative Mortality Risk in Adults with Congenital Heart Disease (PEACH) Score

INTRODUCTION: Previous mortality risk scores for adult cardiac surgery patients did not include adult congenital heart disease (ACHD) patients. Development of ACHD specific mortality risk scores include the procedure-specific ACHS score and recently derived PEACH score. While validated in Europe, further evaluation of the PEACH score in additional settings is necessary. RESEARCH QUESTION: We assessed the efficacy of the PEACH score to predict mortality in ACHD patients undergoing congenital cardiac surgery at our institution. We compared the PEACH score to the ACHS and STS scores and assessed for additional risk factors which may further augment the PEACH score. Methods: A retrospective cohort study was conducted of patients who underwent congenital cardiac surgery at the University of Colorado Hospital and Children’s Hospital Colorado between 2010-2022. Patients were identified by the institutional STS congenital cardiac surgery database and were eligible if 18 years or older and underwent congenital cardiac surgery. Components of the PEACH score and additional postulated risk factors were evaluated by univariate analysis. A receiver operating characteristic (ROC) curve was used to compare the PEACH score to existing risk models. Logistic regression analysis determined additional risk factors to augment the PEACH score. Results: A total of 516 patients were included with a median age of 30 (IQR 23-42) and 51% were male. There were nine deaths overall. The PEACH score was predictive of mortality (OR: 2.09, p&lt;0.001) with a score of 0: 0 deaths/240 patients (0%); 1-2: 6 deaths/229 patients (2.6%); 3+: 3 deaths/41 patients (7.3%). Of additional risk factors tested, platelets less than 184,000 per mcL (OR: 8.36, p=0.01) was significantly associated with mortality. Comparison of the models revealed PEACH score AUC 0.832 (95% CI: 0.740,0.924), ACHS score AUC 0.869 (95% CI: 0.806, 0.932), and STAT AUC 0.769 (95% CI: 0.616, 0.922, Figure 1). The addition of platelet level improved the predictive ability of the PEACH score (AUC 0.881). Conclusion: In this single-center analysis, the PEACH score provided strong predictive ability for peri-operative mortality. The addition of platelet levels may further augment this score.

Abstract Su901: Association of Hemoglobin and Partial Pressure of Oxygen in Arterial Blood on Survival and Neurologic Outcomes in In-Hospital Cardiac Arrest Patients

Background: Lower hemoglobin levels have been associated with poor outcomes in patients with out-of-hospital cardiac arrests. Pre-arrest hemoglobin (within 24 hours) and its association with outcomes and PaO2 in in-hospital cardiac arrest (IHCA) remains unknown. We aimed to evaluate the association of pre-arrest hemoglobin levels with survival and neurologic outcomes, and intra-arrest PaO2 levels in adults with IHCA. Methods: The study population included adults with IHCA undergoing resuscitation at an academic tertiary medical center from 2011-2019. Hemoglobin levels were obtained within 24 hours prior to arrest, and PaO2 levels were obtained intra-arrest via arterial blood gas samples. Patients were classified based upon three pre-arrest hemoglobin (Hgb) levels: Hgb &lt; 8.5, Hgb 8.5-10.5, Hgb &gt; 10.5. Return of spontaneous circulation (ROSC), survival to discharge, favorable neurological outcome (defined as a Glasgow Outcome Score of 4-5), and association with PaO2 served as outcomes of interest. Results: Of the 799 patients studied, 493 patients had pre-arrest hemoglobin data and 164 had intra-arrest PaO2 data. Of those patients that had pre-arrest hemoglobin data, 145 (29.4%) had Hgb &lt; 8.5, 178 (36.1%) had Hgb 8.5-10.5, 170 (34.5%) had Hgb &gt;10.5. Charlson Comorbidity Score was similar across each hemoglobin group. Most patients had PEA/Asystole as the initial rhythm at onset of cardiac arrest, and the number was similar across each hemoglobin group. Mean intra-arrest PaO2 was higher in the Hgb &lt; 8.5 group. Compared to Hgb &lt; 8.5, higher hemoglobin levels were associated with higher rates of ROSC in both univariate (Hgb &lt; 8.5: 46.9% vs. Hgb 8.5-10.5: 59.6% vs. Hgb &gt; 10.5: 62.9%, p = 0.012) and multivariate (Hgb 8.5-10.5: OR 1.51, 95% CI 0.96-2.39; Hgb &gt; 10.5: OR 1.75, 95% CI 1.10-2.79) analyses. Higher hemoglobin levels were associated with higher rates of favorable neurologic outcome in the univariate analysis only (Hgb &lt; 8.5: 10.5% vs. Hgb 8.5-10.5: 11.8% vs. Hgb &gt; 10.5: 19.4%, p = 0.043). There was no significant correlation between pre-arrest hemoglobin and intra-arrest PaO2. Conclusions: In this contemporary registry of adults with IHCA, higher hemoglobin values were associated with higher rates of ROSC. There may be an association between higher hemoglobin levels and favorable neurologic outcome. There was no association between pre-arrest hemoglobin and intra-arrest PaO2.

Abstract Su301: Longer Chest Compression Intervals Between Pulse Checks in Patients with Non-Shockable Rhythms are Associated with Increased Subsequent Return of Spontaneous Circulation Events

Background: Chest compressions are a cornerstone of cardiopulmonary resuscitation (CPR), and evidence shows that fewer interruptions and higher chest compression fractions improve outcomes in cardiac arrest. Interruptions in chest compression are important in patients with shockable rhythms to assess the need for defibrillation; however, in pulseless electrical activity (PEA) or asystole, a pause in chest compressions every 2 minutes may be detrimental, as it decreases chest compression fraction and reduces myocardial, cerebral, and systemic perfusion. Hypothesis: We hypothesize that patients with non-shockable rhythms on whom chest compression intervals were greater than 2 minutes have better odds of achieving return of spontaneous circulation (ROSC). Objective: Our primary objective is to determine if longer chest compression intervals are associated with improved subsequent ROSC in patients with initial PEA or asystole rhythms. Methods: We conducted a retrospective cohort study of video-recorded adult atraumatic cardiac arrest resuscitations in a quaternary care Emergency Department from 1/30/2018 to 2/20/2024. We only examined patients in PEA or asystole and determined the duration of all chest compression intervals for each patient. We grouped the chest compression interval durations into 3 groups (&lt;1min 45sec, 1min 45sec to 2 min 14sec, ≥2min 15 sec) and determined the odds of subsequent ROSC for each chest compression interval duration. We assessed the association between chest compression interval duration and ROSC episodes using a logistic regression model. Results: Out of 326 video-reviewed patients, 235 patients had an initial rhythm of PEA or asystole of which 44 (18.7%) survived to admission and 9 (3.8%) to hospital discharge. The 235 patients yielded 1724 chest compression intervals and 151 ROSC episodes. The ROSC rate for the chest compression intervals &lt;1:45sec was 7.3% (49 out of 673) versus 8.1% (51 out of 632) for intervals 1:45 to 2:14 versus 12.2% (51 out of 419) for intervals ≥2 min 15sec. In a logistic regression model, using the 1min 45 sec to 2min 14 sec interval as the reference group, the &lt;1min 45sec group had 10% lower odds of ROSC (OR: 0.90; 95% CI: 0.60, 1.35) and the ≥2min 15 sec group had 58% higher odds of ROSC (OR: 1.58; 95% CI: 1.05, 2.38). Conclusion: In cardiac arrest patients presenting with non-shockable rhythms, chest compression intervals ≥2 min15sec are associated with higher odds of achieving ROSC.

Abstract Su1204: Impact of Hypothermia vs. Normothermia Temperature Management Based on Body Temperature at Hospital Arrival on 30-Day Neurological Outcomes in Out-of-Hospital Cardiac Arrest Patients: A Nationwide, Retrospective Study in Japan

Introduction: Temperature management (TM) to prevent fever is crucial to mitigate neurological deterioration post-cardiac arrest. Whether hypothermic TM (h-TM) is superior or equal to normothermic TM (n-TM) after out-of-hospital cardiac arrest (OHCA) is debatable, prompting ongoing effects to identify patients who might benefit more from h-TM. We hypothesized that effect of TM would differ based on body temperature at hospital arrival. Aim: Explore which post-cardiac arrest patient subsets might benefit from h-TM by stratifying them based on body temperature at hospital arrival. Methods: This retrospective, observational study used data from the OHCA registry in Japan. Patients 18 years and older who experienced OHCA due to medical cause and received TM in the intensive care unit were included. Primary outcome measure was 30-day favorable neurological outcomes, defined as a Cerebral Performance Category score of 1 or 2. Patients were stratified into groups based on body temperature at hospital arrival: normothermia (36.0-38.0°C), hypothermia (&lt;36.0°C), and hyperthermia (&gt;38.0°C). Effect of TM post-cardiac arrest (h-TM [32-34°C] or n-TM [35-36°C]) was evaluated in each stratified group. Univariable and multivariable logistic regression analysis was used for comparison. Adjusted odds ratio (OR) for favorable neurological outcome with h-TM was calculated using n-TM as a reference. Hyperthermia was excluded from multivariable analyses due to small sample size. Results: We analyzed 3,044 patients, 1,273 in the normothermia group, 1,747 in the hypothermia group, and 24 in the hyperthermia group. Numbers of patients with favorable neurological outcomes were as follows: 530/1,273 (41.6%) in the normothermia group, 584/1,747 (33.4%) in the hypothermia group, and 4/24 (16.7%) in the hyperthermia group. There were no differences in favorable 30-day neurological outcomes between h-TM and n-TM in any stratified group in the univariable analysis: normothermia (h-TM 323/785 [41.2%] vs. n-TM 207/488 [42.4%], p=0.66); hypothermia (411/1,185 [34.7%] vs. 173/562 [30.8%], p=0.11); hyperthermia (3/13 [23.1%] vs. 1/11 [9.1%], p=0.59). Multivariable analysis also showed no differences: normothermia (OR: 0.96, 95% CI: 0.72-1.26), hypothermia (OR: 1.10, 95% CI: 0.85-1.42). Conclusion: TM (h-TM vs. n-TM) did not significantly affect 30-day neurological outcomes, regardless of initial temperature at hospital arrival.

Abstract Su1201: Alteration in cerebrospinal fluid flow in out-of-hospital cardiac arrest patients who underwent target temperature management.

Background: Various parameters of cerebrospinal fluid (CSF) flow measured through magnetic resonance imaging (MRI) flowmetry are utilized to assess the progression of certain diseases. Our study evaluated changes in CSF flow using MRI flowmetry in survivors of out-of-hospital cardiac arrest (OHCA) who underwent target temperature management (TTM). Methods: This prospective observational cohort study was conducted from May 2023 to April 2024 at a single center. We performed Wilcoxon signed-rank tests to compare maximum velocity (V max ), stroke volume (SV), maximum flow (flow max ), and stroke distance measured immediately after return of spontaneous circulation (ROSC) with those measured at 72 h after ROSC. Results: Of the 20 patients enrolled, 7(35.0%), 1(5.0%), 2(10.0%), 5(25.0%) and 5(25.0%) patients had CPC scores of 1, 2, 3, 4, and 5, respectively. V max , SV, flow max , stroke distance measured immediately after ROSC were 3.41 (2.03~4.96), 14.00 (4.00~23.38), 0.09 (0.06~0.22), -0.07 (-0.17~0.05), respectively. V max , SV, flow max , stroke distance measured at 72h after ROSC were 5.26 (2.76~9.28), 24.00 (10.38~42.25), 0.14 (0.08~0.31), -0.07 (-0.18~0.03), respectively. Although V max , SV, and flow max measured at 72 h after ROSC were statistically significantly higher compared to those measured immediately after ROSC (p = 0.002, 0.02, 0.002), there was no significant difference between the stroke distances measured immediately after ROSC and at 72 h after ROSC (p = 0.43). Additionally, the caudocranial direction of CSF flow was observed in 13 (65.0%) patients immediately after ROSC, and in 14 (70.0%) patients 72h after ROSC. Conclusion: This study demonstrated that alterations in cerebrospinal fluid flow were observed in OHCA patients. However, Further studies are needed to determine whether there are differences in alteration in CSF flow based on neurological prognosis.

Abstract 4118341: Outcomes of Heart Failure with Preserved Ejection Fraction Patients With Concurrent Opioid Use: Insights From the National Inpatient Sample

Background: Opioid use has increased significantly in the past few decades, impacting cardiac and non-cardiac patients. As heart failure with preserved ejection fraction (HFpEF) comprises half of all heart failure cases, understanding its management and effect on outcomes is crucial. This study aims to evaluate the outcomes of chronic opioid therapy on HFpEF patients. Methods: Studying the National Inpatient Sample (2016-2020), we identified adult HFpEF patients using the appropriate ICD-10 codes -after excluding patients with end-stage renal disease (ESRD)- and compared outcomes between chronic opioid users and non-users. Multivariate logistic and linear regression analyses were performed, adjusting for multiple patient and hospital confounders. The primary outcome was all-cause in-hospital mortality while secondary outcomes included acute kidney injury/hemodialysis (AKI/HD), cardiogenic shock, cardiac arrest, mechanical ventilation, length of stay, and total charges. Results: Among 1,557,344 HFpEF patients, 21,655 (1.4%) were on opioids chronically. Inpatient mortality was not significantly different between patients who were on opioids and those who were not. (adjusted odds ratio [aOR] 1.01, 95% CI 0.85 - 1.2, p=0.89). There was a non-significant increased risk of cardiogenic shock (aOR 1.14, 95% CI 0.87 - 1.5, p=0.35) and cardiac arrest (aOR 1.05, 95% CI 0.8 - 1.36, p=0.74) in patients on chronic opioids. Chronic opioids were associated with increased risk of AKI/HD (aOR 1.12, 95% CI 1.04 - 1.2, p=0.002) and mechanical ventilation (aOR 1.29, 95% CI 1.16 - 1.43, p&lt; 0.001). Opioid use was also associated with longer hospital stay (adjusted MD [aMD] 1.07 days, 95% CI 0.75 - 1.39, p&lt;0.001) and a non-significant increase in total charges (aMD $2,593, 95% CI -$2,044 - $7,229, p=0.27). Conclusions: While chronic opioid use in hospitalized HFpEF patients did not significantly impact in-hospital mortality, it was associated with increased risk of other adverse events and longer hospital stay. Further research is needed to understand the impact of chronic opioid use on HFpEF patients.

Abstract Su1207: Influence of Duration of Device-based Fever Prevention on Inflammation, Vasopressor Usage, and Oxygen Consumption after Cardiac Arrest - a Substudy of a Randomized Controlled Trial

Background: In the post-resuscitation phase, cardiac arrest patients develop a systemic inflammatory response and fever is likely if not actively treated. The Blood Pressure and Oxygenation Targets after Out-of-hospital Cardiac Arrest (BOX) trial, randomized patients to a total duration of device-based fever prevention for 36 or 72 hours. The trial found no differences in mortality or neurologic outcome. Use of device-based fever prevention for a shorter or longer duration could however result in clinically relevant differences in the magnitude of inflammation, vasopressor usage, and oxygen consumption. Aim: To assess the effect of a shorter or longer duration of device-based fever prevention on inflammation, vasopressor usage, and oxygen consumption in the intervention period from 36 to 72 hours. Methods: The BOX trail [NCT03141099] randomized comatose resuscitated out-of-hospital cardiac arrest (OHCA) patients to three different treatment targets in the post-resuscitation phase: mean arterial blood pressure target of 63 or 77mmHg; oxygenation targets of 68-75 or 98-105 mmHg; and duration of device-based fever prevention in comatose patients for a total of 36 or 72 hours. Endpoints at 48 and 72 hours: leukocytes; CRP; vasoactive-inotropic score (VIS); systemic oxygen consumption determined by use of Fick’s principle. Analyses were performed both on the total BOX population, and for a sensitivity analysis, selectively on patients still comatose at 72 hours (i.e., not awake or dead) as these had the most exposure to the intervention. Results: The total population consists of 789 patients, with 393 and 396 randomized to a total duration of device-based fever prevention for 36 and 72 hours respectively. For the analysis of patients still comatose at 72 hours, 122 and 148 were available for analysis in the 36-hour and 72-hour group respectively. There were no differences between the 36- and 72-hour group for leukocytes, CRP, VIS, or oxygen consumption during the intervention period from 36 until 72 hours, neither for the total population (Figure 1, all p&gt;0.05) or the cohort of patients still comatose at 72 hours (Figure 2, all p&gt;0.05). Conclusions: There were no group differences for patients randomized to device-based fever prevention for 36 or 72 hours with respect to the magnitude of inflammation, vasopressor usage, or oxygen consumption. These findings were consistent for the cohort as a whole, and when examining those with most exposure to the intervention.

Abstract 4137689: Artificial Intelligence Assessment of Diastolic Dysfunction by Electrocardiogram: Outcomes in Cardiac Intensive Care Unit Patients

Background: Left ventricular diastolic dysfunction (LVDD) predicts mortality in cardiac intensive care unit (CICU) patients. A novel artificial intelligence enhanced electrocardiogram (AIECG) algorithm can predict LVDD and mortality in general populations but has not been examined in the cardiac intensive care unit (CICU). We aim to assess if LVDD by AI-ECG is associated with in-hospital and one-year mortality in CICU patients. Methods: In this retrospective cohort study, we included consecutive unique adults admitted to the Mayo Clinic CICU from 2007 to 2018 with an admission AIECG, which AI assigned LVDD grade (0 to 3). Medial mitral E/e’ ratio &gt;15 on transthoracic echocardiogram (TTE) defined elevated filling pressures. AIECG and TTE assessment of LVDD were used to assign patients to four groups based on TTE as gold standard: true and false negative, and true and false positive. In-hospital mortality was evaluated using multivariable logistic regression. One-year survival was evaluated using Kaplan-Meier curves and multivariable Cox proportional-hazards. Results: We included 11,868 patients (median age 69.5 years, 37.7% females); 48% had heart failure and 44% had acute coronary syndromes. AIECG LVDD grades were: grade 0 (normal), 33%; grade 1, 7%; grade 2, 39%; grade 3, 21%. In-hospital (adjusted OR) and one-year (adjusted HR) mortality increased in each higher AIECG LVDD grade (Figure A/B), before and after adjustment including TTE measurements. Patients with grade 2-3 LVDD by AIECG and medial mitral E/e’ ratio &gt;15 by TTE (true positive) had the highest in-hospital (adjusted OR 2.5 [1.7-3.9]) and one-year (adjusted HR 1.9 [1.5-2.5]) mortality (Figure C/D), and mortality was elevated similarly in patients with either grade 2-3 LVDD by AIECG (false positive) or medial mitral E/e’ ratio &gt;15 by TTE (false negative). Conclusions: The AIECG LVDD grade was strongly associated with in-hospital and one-year mortality in CICU patients, even after adjusting for clinical variables and TTE measurements. Patients with concordant AIECG and TTE for elevated filling pressures (true positive) were at highest risk.